Perioperative morbidity in total knee arthroplasty

Abstract

Introduction: as the life expectancy and weight of patients are increasing, more old and obese patients are undergoing total knee arthroplasty
(TKA). TKA may lead to several perioperative complications. These include anesthesia-related risks, exacerbation of comorbid medical issues and
complications of surgical procedure. We have no studies reporting medical complications following TKA among our population. This study aimed to
evaluate perioperative complications of TKA and to identify the related risk factors. Methods: it was a monocentric retrospective including 410
observations in the local TKA registry. Data of patients operated for primary unilateral TKA during the period from January 2014 to December 2017
were reviewed. All patients had standardized protocols of anesthesia and post operative care for three days following surgery. Multivariate logistic
regression was used to identify the predicting factors for complications. Results: incidence of perioperative complications was 37.1%. The most
frequent were per operative hypotension (14.1%) and postoperative desaturation (21.7%, including pulmonary embolism in 2.4%). Multivariate
logistic regression analysis identified: age ≥ 65 years (OR=1.9; p=0.006), respiratory diseases (OR=1.8; p=0.042) and general anesthesia (OR=2.8;
p=0.009) as significant risk factors for any complications. Loss of autonomy (OR=4.8; p <0.001) and general anesthesia (OR=2.6; p=0.03) were
significant risk factors for hypotension. Age ≥ 65 years (OR=2.6;p<0.001), female gender (OR=4.3;p=0.006) and respiratory
diseases(OR=1.9;p=0.02) were associated with postoperative desaturation. Conclusion: this study highlighted hemodynamic and respiratory
complications as the most common early complications in TKA. Age ≥ 65years, general anesthesia and respiratory diseases were significant risk
factors.